Healthcare Provider Details

I. General information

NPI: 1013696335
Provider Name (Legal Business Name): JESSICA JO SALVATORE PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2023
Last Update Date: 02/17/2026
Certification Date: 02/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2360 E PERSHING BLVD
CHEYENNE WY
82001-5356
US

IV. Provider business mailing address

2360 E PERSHING BLVD
CHEYENNE WY
82001-5356
US

V. Phone/Fax

Practice location:
  • Phone: 307-778-7550
  • Fax:
Mailing address:
  • Phone: 307-778-7550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number23037
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number10668
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: